Chapter 107 - Treatment of the herniated disc

Summary

Herniated discs usually occur in the cervical and lumbar spine. The thoracic spine is relatively non-mobile due to the attached rib cage and therefore is less commonly affected by disc herniations. Herniated discs typically occur in younger patients between ages 30 and 50 years and present primarily with appendicular pain (radicular pain of arm, leg) as well as axial pain (mechanical pain of neck, back). Cervical and thoracic discs may present with myelopathy due to spinal cord compression or radiculopathy from nerve root compression. Sometimes, a combination of myelopathic and radiculopathic symptoms is present. The majority of patients with a disc herniation obtain relief with conservative treatment. Herniated discs are the initial manifestations of the continuum of degenerative disc disease that is later manifested by dehydration of disc material, loss of disc space height, associated facet joint arthropathy, and the development of osteophytes.

Cervical level

Patients with cervical disc herniation typically present with arm and periscapular pain, and often with weakness, numbness, or paresthesias in a nerve root distribution. The majority of patients improve with non-surgical therapeutic options such as cervical collar immobilization rest, non-steroidal anti-inflammatory or corticosteroid medications, traction, and physical therapy. Sometimes epidural steroid injections or foraminal steroid injections are helpful. Typically, patients with troublesome symptoms that do not resolve with these non-surgical measures and that persist beyond 6 weeks–3 months are considered to be candidates for surgery. Patients with significant weakness or sensory loss may opt for surgery sooner.